Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Sublingual versus Vaginal Misoprostol for the Induction of Labor at Term: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial7985ENBahiaNamavar JahromiMaternal-Fetal Medicine Research Center, Infertility Research Center, Department of Gynecology and Obstetrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. namavarb@sums.ac.irForooghPoorgholamGholamhosseinYousefiLeilaSalarian2014030620140723Background: We sought to compare the effectiveness and safety of sublingual versus vaginal misoprostol for the termination of pregnancy with a live full-term fetus.Methods: This randomized, triple-blind, placebo-controlled clinical trial was performed on 200 primiparous women with normal, singleton, full-term pregnancies candidated for the induction of labor. Sublingual and vaginal tablets containing misoprostol (25 mcg) or placebo in similar shapes were administered every 4 hours until the Bishop score reached above 8. Maternal and neonatal complications and outcomes were compared.Results: There were 100 parturient women in each group. The mean maternal age, gestational age, and Bishop score at the commencement of misoprostol had no statistical differences between the sublingual and vaginal groups. The mean time interval between misoprostol commencement and delivery was 497.10±291.49 and 511.67±08.46 minutes for the sublingual and vaginal groups, correspondingly. Twenty-two women had Cesarean deliveries in the sublingual group versus 14 in the vaginal group. Meconium-stained amniotic fluid was seen in 12 women in the sublingual group and 4 in the vaginal group (P=0.03). Late fetal heart rate deceleration was observed in 8 women in the sublingual group and 4 in the vaginal group (P=0.22). The mean neonatal birth weight, blood gas value at birth, Apgar score, and length of admission time in the neonatal intensive care unit were not different between the 2 groups.Conclusion: Sublingual and vaginal misoprostol had similar effectiveness; however, meconium-stained liquor was observed considerably more frequently with sublingual misoprostol than with vaginal misoprostol.Trial Registration Number: IRCT201402096541N3Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Level of Agreement between Children with Asthma and their Parents on Quality of Life8693ENMaryamKhoshkhuiDepartment of Allergy and Clinical Immunology, Mashhad University of Medical Sciences, Mashhad, Iran. khoshkhuim@sums.ac.irPeymanJafariMaryamAfrasiabiMarziehOroojSaraKashef2014031620140915Background: Child-parent agreement is a controversial aspect of measuring health-related quality of life (HRQoL) in children and adolescents. The aim of this study was to assess the agreement between the child self-reports and parent proxy reports of the PedsQL 3.0 Asthma Module in Iranian children with asthma to evaluate HRQoL. Moreover, the psychometric properties of the child and parent reports of the PedsQL 3.0 Asthma Module were assessed in the present study.Methods: Participants were 112 children with asthma and their parents, who completed the Farsi version of the PedsQL 3.0 Asthma Module. The multitrait-multimethod correlation matrix and factor analysis were used to test whether the child self-reports and the parent proxy reports measured the same construct. Additionally, convergent and discriminant validity and internal consistency were assessed using the Pearson correlation.Results: The correlation between the child and parent HRQoL perceptions ranged between 0.13 and 0.36 across the same domains. Our factor analysis revealed that the child self-reports and the parent proxy reports measured 2 different constructs of HRQoL. Furthermore, our findings showed that both the child self-reports and the parent proxy reports of the PedsQL 3.0 Asthma Module had excellent internal consistency and acceptable convergent and discriminant validity.Conclusion: Although the child self-reports and the parent proxy reports of the Farsi version of PedsQL 3.0 Asthma Module showed good psychometric properties, they were not interchangeable. Our children with asthma and their parents evaluated child HRQoL from their own viewpoints.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Comparison of the Wave Amplitude of Visually Evoked Potential in Amblyopic Eyes between Patients with Esotropia and Anisometropia and a Normal Group94101ENMohammad RezaTalebnejadPoostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. talebnejadmr@yahoo.comSaeedehHosseinmenniEbrahimJafarzadehpurAli MirzajaniEnayatollah Osroosh2014041920140813Background: We compared the wave amplitude of visually evoked potential (VEP) between patients with esotropic and anisometropic amblyopic eyes and a normal group.Methods: The wave amplitude of VEP was documented in 2 groups of persons with amblyopia (15 with esotropia and 28 with anisometropia) and 1 group of individuals with normal visual acuity (n, 15). The amplitude of P100 was recorded monocularly with different spatial frequencies.Results: Our statistical analysis revealed that the wave amplitude in the 2 groups with amblyopia was significantly decreased compared to that in the normal group (P&lt;0.001). There was a significant difference regarding the amplitude in high spatial frequencies in both high- and low-contrast conditions between the groups with esotropia and anisometropia and the normal group (P&lt;0.001). There were also significant differences in large check-size stimuli and low-contrast condition between the amblyopic groups with esotropia and anisometropia and the normal group (P=0.013 and P=0.044, respectively). In large check-size stimuli and high-contrast condition, a significant difference was indicated only in the comparison between the esotropic amblyopic eyes and the normal eyes (P=0.036).Conclusion: The wave amplitude parameter of VEP was influenced by both types of amblyopia, but it seems that this parameter was more sensitive to esotropic amblyopia than anisometropic amblyopia. This outcome may reflect a non-parallel pattern of cortical responses in the comparison of the 2 types of amblyopia with each other and with the control group, which may be beneficial for the diagnosis and treatment of amblyopia.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Effects of Sesame Butter (Ardeh) versus Sesame Oil on Metabolic and Oxidative Stress Markers in Streptozotocin-Induced Diabetic Rats102109ENFatemehHaidariNutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Haidari58@gmail.comMajidMohammadshahiMehdiZareiZahraGorji201405282014111120140924Background: Diabetes is one of the most common metabolic disorders and is related to oxidative-stress-induced diseases. Given the role of dietary antioxidants in the control and prevention of diabetes, this study aimed to examine the effects of sesame butter versus sesame oil on the serum levels of glucose, lipid profile, and oxidative stress biomarkers in diabetic rats.Methods: Forty male albino rats of Wistar strain were randomly divided into 4 groups (i.e., nondiabetic control rats, diabetic rats, diabetic rats treated with sesame butter, and diabetic rats treated with sesame oil). Experimental diabetes was induced with an intraperitoneal injection of streptozotocin (55 mg/kg). Sesame butter (1.25 g/kg) and sesame oil (0.5 g/kg) were given by oral gavage to the diabetic rats for 6 weeks. Finally, serum glucose, lipid profile, total antioxidant capacity (TAC), and malondialdehyde (MDA) levels were measured and analyzed statistically.Results: Our data showed that the diabetic groups treated with sesame butter and sesame oil had significantly lower levels of glucose and higher levels of high-density lipoprotein than did the diabetic control group at the end of the study (P&lt;0.05). Sesame butter supplementation also increased TAC and decreased MDA concentrations significantly in the diabetic rats (P&lt;0.05).Conclusion: The antihyperglycemic, antioxidative, and partly lipid-lowering effects of sesame butter make it an excellent candidate for future human studies on diabetes, although further research is needed to determine the exact dose and duration of supplementation.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Relation between Working Memory Capacity and Auditory Stream Segregation in Children with Auditory Processing Disorder110117ENYonesLotfiDepartment of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. lotfi1333@gmail.comSaiedehMehrkianAbdollahMoossaviSoghratFaghih ZadehHamedSadjedi2014050420140813Background: This study assessed the relationship between working memory capacity and auditory stream segregation by using the concurrent minimum audible angle in children with a diagnosed auditory processing disorder (APD).Methods: The participants in this cross-sectional, comparative study were 20 typically developing children and 15 children with a diagnosed APD (age, 9–11 years) according to the subtests of multiple-processing auditory assessment. Auditory stream segregation was investigated using the concurrent minimum audible angle. Working memory capacity was evaluated using the non-word repetition and forward and backward digit span tasks. Nonparametric statistics were utilized to compare the between-group differences. The Pearson correlation was employed to measure the degree of association between working memory capacity and the localization tests between the 2 groups.Results: The group with APD had significantly lower scores than did the typically developing subjects in auditory stream segregation and working memory capacity. There were significant negative correlations between working memory capacity and the concurrent minimum audible angle in the most frontal reference location (0° azimuth) and lower negative correlations in the most lateral reference location (60° azimuth) in the children with APD.Conclusion: The study revealed a relationship between working memory capacity and auditory stream segregation in children with APD. The research suggests that lower working memory capacity in children with APD may be the possible cause of the inability to segregate and group incoming information.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Biphasic Response to Luteolin in MG-63 Osteoblast-Like Cells under High Glucose‑Induced Oxidative Stress118125ENNaserAbbasiDepartment of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. abbasi-n@medilam.ac.irAfraKhosraviAliAidyMassoumehShafiei2014071420140915Background: Clinical evidence indicates the diabetes-induced impairment of osteogenesis caused by a decrease in osteoblast activity. Flavonoids can increase the differentiation and mineralization of osteoblasts in a high-glucose state. However, some flavonoids such as luteolin may have the potential to induce cytotoxicity in osteoblast-like cells. This study was performed to investigate whether a cytoprotective concentration range of luteolin could be separated from a cytotoxic concentration range in human MG-63 osteoblast-like cells in high-glucose condition.Methods: Cells were cultured in a normal- or high-glucose medium. Cell viability was determined with the MTT assay. The formation of intracellular reactive oxygen species (ROS) was measured using probe 2’,7’ -dichlorofluorescein diacetate, and osteogenic differentiation was evaluated with an alkaline phosphatase bioassay.Results: ROS generation, reduction in alkaline phosphatase activity, and cell death induced by high glucose were inhibited by lower concentrations of luteolin (EC50, 1.29±0.23 µM). Oxidative stress mediated by high glucose was also overcome by N-acetyl-L-cysteine. At high concentrations, luteolin caused osteoblast cell death in normal- and high-glucose states (IC50, 34±2.33 and 27±2.42 µM, respectively), as represented by increased ROS and decreased alkaline phosphatase activity.Conclusion: Our results indicated that the cytoprotective action of luteolin in glucotoxic condition was manifested in much lower concentrations, by a factor of approximately 26 and 20, than was its cytotoxic activity, which occurred under normal or glucotoxic condition, respectively.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Efficacy of Biofeedback Therapy before and after Sphincteroplasty for Fecal Incontinence because of Obstetric Injury: A Randomized Controlled Trial126131ENLeilaGhahramaniColorectal Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. leila_ghahramani@yahoo.comMastourehMohammadipourRezaRoshanravanFahimehHajihosseiniAlimohammadBananzadehAhmadIzadpanahSeyed VahidHosseini2014031020140820Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence.The present randomized controlled trial was performed on 27 women with a complaint of fecal incontinence because of delivery trauma. The patients underwent sphincteroplasty and levatorplasty via the same method by 2 colorectal surgeons. In Group I, biofeedback therapy was performed 3 months before and 6 months after the surgery; in Group II, biofeedback therapy was applied only 6 months after the surgery; and in Group III, only surgical management was performed.The results revealed a significant difference between the preoperative and postoperative Wexner scores of incontinence in all the 3 groups. Additionally, the difference between the preoperative and postoperative scores was significant only in Group I and Group III, but not in Group II. The reduction in the Wexner score was significantly less in Group III. However, no significant difference was observed between the 3 groups concerning the mean difference of preoperative and postoperative manometry.The present study revealed no significant role for biofeedback therapy alone in the improvement of manometric evaluation. However, the Wexner score, which is an indicator of patient satisfaction, increased with biofeedback therapy following sphincteroplasty.In general, surgical treatment is now reserved for selected patients with fecal incontinence and has recently been developed with biofeedback therapy.Trial Registration Number: IRCT201206039936N1Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Growth Kinetics, Characterization, and Plasticity of Human Menstrual Blood Stem Cells132139ENDavoodMehrabaniStem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. mehrabad@sums.ac.irRoshanakBahrami NazarabadiMaryamKasraeianAminTamadonMehdiDianatpourAkbarVahdatiShahrokhZareFarnazGhobadi2014092020150106One of the readily available sources of mesenchymal stem cells (MSCs) is menstrual blood-derived stem cells (Men-SCs), which exhibit characteristics similar to other types of MSCs. This study was performed to determine the growth kinetics, plasticity, and characterization of Men-SCs in women. During spring 2014 in the southern Iranian city of Shiraz, menstrual blood (5 mL) was obtained from 10 women on their third day of menstruation in 2 age groups of 30 to 40 and 40 to 50 years old. Ficoll was used to separate the mononuclear cell fraction. After the Men-SCs were cultured, they were subcultured up to passage 4. Growth behavior and population doubling time were evaluated by seeding 5×104 cells into 12- and 24-well culture plates, and the colonies were enumerated. The expression of CD44, CD90, and CD34 was evaluated. The osteogenic potential was assessed by alizarin red staining. The Men-SCs were shown to be plastic adherent and spindle-shaped. Regarding the growth curves in the 12- and 24-well culture plates, it was demonstrated that in the women aged between 30 and 40 years, population doubling time was 55.5 and 62 hours, respectively, while these values in the women aged between 40 and 50 years were 70.4 and 72.4 hours, correspondingly. Positive expression of CD44 and CD90 and negative expression of CD34 were noted. In the osteogenic differentiation medium, the cells differentiated toward osteoblasts. As human Men-SCs are easily collectable without any invasive procedure and are a safe and rapid source of MSCs, they can be a good candidate for stem cell banking and cell transplantation in women.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Effectiveness of Spiritual Group Therapy on Quality of Life and Spiritual Well-Being among Patients with Breast Cancer140144ENSakinehZamaniyanDepartment of Psychology, Islamic Azad University, Karaj Branch, Karaj, Iran. zamaniyan37@gmail.comJafarBolhariGhasemNaziriMajidAkramiSaraHosseini201404162015050320140625Cancer is deemed the century’s major health problem, and its increasing growth during the last decades has made experts concerned more than ever. Of all types of cancer, breast cancer is regarded as the second most common disease among women. The aim of this study was to determine the effectiveness of spiritual group therapy on quality of life and spiritual well-being among patients suffering from breast cancer. The present research was carried out between March and June 2011. The sample consisted of 24 participants randomly assigned to 2 groups: an experimental group (n, 12) and a control group (n, 12). All the subjects completed questionnaires on quality of life and spiritual well-being in pretest and posttest. The experimental group received 12 sessions of spiritual group therapy. The results demonstrated improvement in quality of life and spiritual well-being in the experimental group. In conclusion, spiritual group therapy can be used to improve quality of life and spiritual well-being (religious health and existential health) among patients with breast cancer.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Aggressive calcifying epithelial odontogenic tumor masquerading as maxillary sinus tumor: a case report.145149ENVidyaRaniDepartment of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Pallikaranai, Chennai, Tamil Nadu, India. drvidyaranishyam78@gmail.comMahaboob KadarMasthanBabuAravindhaSankariLeena201401082014051920140326Calcifying epithelial odontogenic tumor is a rare odontogenic neoplasm. Its occurrence in the maxillary sinus is very rare. Maxillary tumors tend to be locally aggressive and may rapidly involve the surrounding vital structures. We report a case of calcifying epithelial odontogenic tumor involving maxillary sinus in a 48 years old female patient with the oral mucosal involvement. The purpose of this article is to report an additional case of calcifying epithelial odontogenic tumor and discuss the radiologic appearance, histologic features, and to highlight its clinical behavior.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Intracardiac Thrombosis in Sickle Cell Disease150153ENMarziehNikparvarCardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. marzieh_nikparvar@yahoo.comMohammad RezaEvaziTasnimEftekhariFarzanehMoosavi2014030720140811In patients with sickle cell disease, thrombotic microangiopathy is a rare complication. Also in sickle cell disease, intracardiac thrombus formation without structural heart diseases or atrial arrhythmias is a rare phenomenon. We herein describe a 22-year-old woman, who was a known case of sickle cell-βthalassemia, had a history of recent missed abortion, and was admitted with a vaso-occlusive crisis. The patient had manifestations of microangiopathic hemolytic anemia, including laboratory evidence of hemolytic anemia, thrombocytopenia, respiratory distress, fever, jaundice, and abnormal liver function and coagulation tests, accompanied by clot formation on the Eustachian valve of the inferior vena cava in the right atrium and also a long and worm-like thrombus in the right ventricle. Therapeutic plasma exchange improved her clinical condition, and her intracardiac thrombus was completely resolved after 1 week. Echocardiography, as a simple and inexpensive imaging modality, had a significant role in the diagnosis and follow-up of this patient.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Exsanguinating Hemorrhage during Open Biopsy in a Primary Breast Angiosarcoma: A Case Report154156ENMajidAkramiBreast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran. akramimd@yahoo.comMastourehMohammadipourMaralMokhtariMaliheDayani2014013120140519Angiosarcomas are endothelial cell neoplasms in the lining of the blood vessel wall and account for about 0.04% of all breast malignancies with a high rate of error in primary diagnosis. The breast angiosarcoma is a rare and uncommon pathology and has been described mostly as case reports. Indeed, only a limited number of cases have been published. Accordingly, the natural history of this tumor and its clinical course remain unclear, and as a consequence, no uniform treatment strategy exists. We present the clinical course and challenges in the diagnosis of a primary angiosarcoma of the breast in a young woman, presenting with a mass in her left breast. Fine-needle aspiration and core needle biopsy failed to confer a correct diagnosis. She suffered severe bleeding at the time of open biopsy and underwent total mastectomy, followed by adjuvant chemotherapy. Young women with solid breast tumors, especially those that are highly vascular, should be considered malignant until proven otherwise. Accurate diagnosis may be difficult. Open biopsy can be diagnostic, although exsanguinating bleeding may occur. Thus, performing open biopsy in locations other than equipped operating rooms may be hazardous and should be avoided.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case157160ENGhodratollahMaddahEndoscopic and Minimally Invasive Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Maddahgh@yahoo.comAsieh SadatFattahiAliRahnamaShirinTaraz Jamshidi2014022020140615A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation — she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months’ postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Minor Contribution of inhA-15 Mutations to the Rapid Detection of Isoniazid Resistance in Mycobacterium Tuberculosis Isolates161163ENRoyaAbkarDepartment of Microbiology, Qom Branch, Islamic Azad University, Qom, Iran. mmatinam81@yahoo.comMohammad RezaZolfaghariMohammadArjomandzadeganAzamAhmadiMaryamSadrniaManijehKahbaziHosseinSarmadianRezaMoaddab2015032220150928Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071641220160118Nodular Melanoma164165ENMuhammadSaaiqPakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan. muhammadsaaiq5@gmail.comBushraAshrafSaadSiddiqui2015101420151214